Iodine-125 Brachytherapy Prophylaxis after Radiofrequency Ablation Cannot Benefit Patients in High Risk of Locoregional Hepatocellular Carcinoma Recurrence

Abstract

This study evaluated if iodine-125 brachytherapy prophylaxis after radiofrequency ablation (RFA) prolongs time to recurrence (TTR) and overall survival (OS) of patients in high risk of locoregional hepatocellular carcinoma (HCC) recurrence. 116 patients with total tumor necrosis after RFA were divided into iodine-125 brachytherapy prophylaxis treatment group and control group. The primary endpoint was TTR, and secondary endpoints were OS and treatment-related adverse events. There were no significant differences among the baseline characteristics of two subgroups patients. The mean iodine-125 particles were 29.8 (26.59 ± 12.51 mCi) per patient. The mean follow-up was 25 months, and mean TTR of treatment and control groups were 21.7 and 15.9 months (P = 0.733); mean OS of two subgroups were 41.7 and 40.9 months (P = 0.316). There were no significant differences of 1-, 2-, 3-, 4-and 5-years TTR and OS and patients’ immunity pre- and 1 month post-treatment. Extrahepatic metastasis was found to have a statistically significant influence on TTR, and AFP, extrahepatic metastasis were found to have a statistically significant influence on OS by multivariate analysis. There was no major complications and procedure related death. Iodine-125 brachytherapy prophylaxis after RFA can’t improve TTR and OS of HCC patients who were in high risk of locoregional tumor recurrence.

Feasibility, safety, and long-term efficacy of stereotactic radiofrequency ablation for tumors adjacent to the diaphragm in the hepatic dome: a case-control study

“…The technical success rate, i.e., completion according to plan, in our study was 100%, which is in line with reports from the literature [5,18]. The primary technical efficacy was 97.5%, also comparable with reported primary technical efficacy rates after conventional RF ablation in the hepatic dome ranging from 86.7% [5] to 93.2-96% [19,20]. The conventionally treated tumors were smaller (median diameter 1.7 cm and maximal diameter 4 cm) compared with our study with a median tumor size of 2.2 cm and a maximal diameter of 10 cm.…”

“…According to the in-surgical studies that primarily used Clavien-Dindo classification [30], the major complicate rate in the present study was 4.9% (10/204). Major complication rates after laparoscopic RFA were 10% and 12.4%, respectively [20,31]. Several surgical studies report significantly higher major complicate rates of 10-27% after LLR, and 18-37% after open resection, respectively [10,[32][33][34][35].…”

“…Rhim et al [29] reported a low complication rate of 4% (1/25) with artificial ascites during RF ablation of subdiaphragmatic tumors, and Kim et al [5] described no major complications in a small series of 15 patients treated by RF ablation with an angulated transhepatic approach. More recently, Vo Chieu et al [18] reported major complication rates of up to 57.9% with microwave ablation in subcapsular hepatic dome tumors with a transpleural approach while Ding et al [20] reported major complication rate of 10% (6/60) with a transhepatic approach. Asvadi et al [22] showed that creation of artificial ascites is a valuable option for avoiding diaphragm-associated complications.…”

Combined Ultrasound and CT-Guided Iodine-125 Seeds Implantation for Treatment of Residual Hepatocellular Carcinoma Located at Complex Sites After Transcatheter Arterial Chemoembolization

“…It has been reported that 125 I brachytherapy can achieve high locoregional tumors control ( 35 ). The study by Chen et al.…”

“…The application of TACE is also limited due to the extrahepatic collateral arteries and the non-dense deposition of iodide oil (6,11). It has been reported that 125 I brachytherapy can achieve high locoregional tumors control (35). The study by Chen et al (27) showed that compared with RFA alone, RFA combined with 125 I seeds implantation could significantly improve OS and cumulative recurrence in patients with small HCCs.…”